Healthcare Provider Details

I. General information

NPI: 1902475551
Provider Name (Legal Business Name): ALICE CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SAGAMORE DR
PLAINVIEW NY
11803-1516
US

IV. Provider business mailing address

53 SAGAMORE DR
PLAINVIEW NY
11803-1516
US

V. Phone/Fax

Practice location:
  • Phone: 347-259-2916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346418-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: